Winter 2022 (Volume 32, Number 4)
Death by PowerPoint
By Philip A. Baer, MDCM, FRCPC, FACR
“I hate the way people use slide presentations instead of thinking. People would confront a problem by
creating a presentation. I wanted them to engage, to hash things out at the table, rather than show a bunch
of slides. People who know what they're talking about don't need PowerPoint.”
– Steve Jobs
Recently, American TV channels I still watch have
been peppered with ads, not just for biologics (psoriasis
and inflammatory bowel disease being especially
popular) but for Canva, a graphic design platform
devoted to presentation software. Since developing and
presenting information is an activity I am frequently involved
with, I looked into this company further. Canva is
an Australian tech unicorn (valuation > $1 billion) which
promises that you will “impress your audience, and yourself.”
You can present from anywhere and captivate the
crowd. An example provided is that pressing the “C” key
will send confetti streaming across the screen. Not sure
how professional that will look in the medical-scientific
context! It reminded me of the early days of PowerPoint
when a world-famous rheumatologist new to the program
enlivened every slide with dizzying special effects. Of
course, I remember that, but none of the actual content
presented that day.
Prezi is another alternative to traditional PowerPoint.
This Hungarian company provides a visual storytelling
platform instead of using traditional slides. “Prezi presentations
feature a map-like overview that lets users pan
between topics, zoom in on details, and pull back to reveal
context.” They were also early movers into the virtual
presenting space, even pre-pandemic. To date, I have
attended and enjoyed one or two live Prezi rheumatology
presentations, so their traction in our field has been
Why do we need Canva and Prezi? Maybe because
PowerPoint, or the way we use it, has been found to be
fundamentally flawed. PowerPoint the word has become
akin to the word Kleenex: a particular variety of presentation
software that has come to represent the whole field.
Whether you use the original Microsoft version, or those
provided by Apple, Google, or other third-party vendors,
we’re in the same territory.
We all use it, but are there issues we should consider
when we do? An inquiry into the Columbia space shuttle
disaster found that the risks of catastrophe after its problematic
launch were well-described in PowerPoint slides
prepared by a team of engineers. However, they were buried
so low in the slide master hierarchy that they were
hard to find and were overwhelmed by more positive language
in the slide titles, which might be all an attendee
would read and remember.1 A satirical look at what Lincoln’s
Gettysburg Address would have looked like in
PowerPoint highlighted its destructive potential versus
the eloquence of the actual speech.2
Rheumatology presentations can be enhanced by
storytelling. That’s why starting with a case, especially a
real one, can make the content that follows more compelling.
What else can we do?
Well, my original PowerPoint guru was Dave Paradi.
His idea was basically to improve your slides to help the
audience learn. First came "The Visual Slide Revolution:
Transforming Overloaded Text Slides into Persuasive Presentations".
A picture, graph, bar chart is worth a thousand
words, etc. A great idea which still has not been
adequately implemented in most medical presentations.
Next up was "Present It So They Get It: Create and Deliver
Effective PowerPoint Presentations Your Audience Will
Understand". That one gets at the heart of the issue: communicating
well involves transmitting your ideas to your
listeners in a way that will make the imparted knowledge
Lately, however, another school of thought has become
more popular: that the problem is with PowerPoint itself,
and no amount of slide massaging will help. The most
prominent voice on that theme is Eric Bergman.
One study cited looked at an engineering course at
Purdue University where the same material was delivered
with and without slides. Students who didn’t see
any slides scored higher on a subsequent test. Interestingly,
students who skipped the lecture entirely, read the
textbook and then took the test also scored higher than
those who attended the PowerPoint lecture.
Another study at the University of Munich tested regular
(6 lines of 6 words) versus concise slides (about 12
words/slide) versus simply talking without slides. Again,
the results showed simply talking to the audience led to
greater overall retention of the presented information.
A 2012 study of religious sermons showed a sermon
without slides was the most effective form of communication,
compared to sermons using word slides, visual
image slides or a combination of the 2 types of slides.3
Quoting Eric Bergman: “In other words, use as many
slides as you wish, as long as you don’t want the audience
to remember what you said. If you want to increase what
the audience remembers (and who on earth wouldn’t?),
turn off the projector. Don’t share your slides. Simply
carry on a conversation with your audience.”
In a less stringently regulated time, I used to enjoy
presenting on osteoporosis to primary care physicians
by simply hosting a roundtable without slides, using an
“Ask the Expert” format. Once the ice was broken, and the
first question was posed, the time flew by. I always left
feeling that the audience had driven the discussion and
had their key questions answered. Maybe we need more
of that style of talk.
PowerPoint is clearly habit-forming. Will the evidence
help us break this potentially bad habit? Only time will
Philip A. Baer, MDCM, FRCPC, FACR
1. James Thomas. Death by PowerPoint: the slide that killed seven people. Available at https://mcdreeamiemusings.com/blog/2019/4/13/gsux1h6bnt8lqjd7w2t2mtvfg81uhx. Accessed November
2. Gettysburg Cemetery Dedication presentation. Available at https://norvig.com/Gettysburg/.
Accessed November 16, 2022.
3. Buchko AA, Buchko KJ, Meyer JM, et al. Is there power in PowerPoint? A field test of the efficacy
of PowerPoint on memory and recall of religious sermons. Computers in Human Behavior, 2012;